I have received from requests to write a post on the Best Step 2 CS resources. Although Step 2 CS requires significantly less dedicated prep time than CK, it also, unfortunately, requires more digging around for what the best books for Step 2 CS are.
Unfortunately, what makes Step 2 CS so frustrating is there is a lot of unknowns regarding how it is graded. I’ll share what is known (from the NBME) and what resources I used comfortably pass my test.
Study Plan for Step 2 CS
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- USMLE Step 2 CS Manual
- First Aid for the USMLE Step 2 CS
- USMLE Step 2 CS Complex Cases: Challenging Cases for Advanced Study
- Physical Exam Videos (below)
- General OSCE tips (below)
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Where to start
Familiarize yourself with the information in the info manual about the test provided by the test makers’ themselves. Before you start preparing for the exam, I would concentrate on pages 10-11 about scoring and pages 15-18 which show a blank patient note as well as a sample patient note to guide your studying with the non-USMLE sources below. Given it’s not a tremendous amount of information, they do provide examples of things that result in higher or lower scores.
Best Books for Step 2 CS
First Aid Step 2 CS
In my opinion this book is as essential for CS as First Aid is for Step 1. What makes this book so essential is the examples it provides. From examples of “difficult patients/scenarios” you may encounter (e.g. the patient who refuses to answer your questions, the crying patient), examples of questions SPs may throw at you as “challenge questions” (both in real life and on the test) and examples of what to ask on certain chief complaints that always trip you up, and most important examples of differentials of common chiefly complaints you will see in an ambulatory medicine office or ED (and therefore on CS). One of the most helpful things I did for CS was to make flashcards using the differentials featured in the minicases. This helped me commit these differentials to memory which was invaluable time saver.
Another great tip that was passed on to me was to take time before my test to memorize the example “normal” physical exam findings table provided by First Aid. This will be another tremendous time saver when you are writing your physical exam findings on the exam. It’s quicker to know the negative exam findings by heart and then to add any positive exam findings you may find.
Supplemental Resources
USMLE Step 2 CS Complex Cases or the Kaplan Complex Cases Book
I think First Aid would be more than sufficient for most test takers, but I thought reading this after First Aid reinforced the material further and helped me enter the test more confidently. A strength of the core cases book over FA is that it has more specific tips for the CIS that may be less obvious.
I bought this because I credit UWorld with raising my CK score significantly and it has a much lower price tag than the CK question set. I never got around to finishing this resource because I did not find it covered much that First Aid did not.
One benefit of this resource were the included physical exam videos. I would recommend UWorld for Step 2 CS for anyone who has 1+ month to prepare for CS and really needs the reinforcement of physical exam skills (e.g. took a gap year after third year or little US clinical experience). Otherwise, for most students, using free physical exam videos on youtube will suffice for the maneuvers you need to refresh on.
Physical Exam Preparation
The best way to prepare for the actual physical exam maneuvers is to study with a partner. First Aid for the USMLE Step 2 CS
Although there are several texts out there which describe physical exam maneuvers in more detail (I used Bates’ Pocket Guide to Physical Examination and History Taking
A youtube search will get you to what you’re looking for, but I’ve included a random assortment of physical exam videos I have used throughout third year:
Free Physical Exam Videos for Step 2 CS:
HEENT Exams:
•Geeky Medics – Examination of the Eyes and Vision
•HEENT exam – clinical examination series
•HEENT exam video (longer, but thorough, if you need the review)
Special tests
•Rinne and Weber Test
•Lymph Node exam in the Head and Neck
Cardiovascular Exams:
•Geeky Medics – Cardiovascular exam OSCE guide
•Geeky Medics – Peripheral Vascular exam OSCE guide
•Measuring JVP
Pulmonary Exams:
•Geek Medics – Respiratory exam OSCE guide
•Chest percussion (lengthy, but thorough)
Abdominal Exams:
•Geeky Medics – Abdominal exam OSCE guide
•Abdominal exam from Manchester Medical School
Special tests
•Liver examination
•Spleen examination
•Murphy’s Sign
•Rovsing’s Sign
•Obturator and Psoas Signs
Musculoskeletal Exams:
•Geeky Medics – Shoulder exam OSCE guide
•Knee Exam (lengthy, but thorough)
Special tests
•Physiotutors McMurrary Test
•Physiotutors Straight Leg Raise
•Physiotutors Neer Test
•Physiotutors Empty Can or Jobe test
•Physiotutors Drop Arm test
•Physiotutors Hawkins test
•Physiotutors Lachman test
•Physiotutors Anterior Drawer test
•Physiotutors Posterior Drawer test
•Physiotutors Thompson test
Neuro exams:
•Deep Tendon Reflexes
•Geeky Medics – Upper extremity exam OSCE guide
•Geeky Medics – Lower extremity exam OSCE guide
•Geeky Medics – Cranial Nerve exam OSCE guide
•Geeky Medics – Cerebellar exam OSCE guide
Special tests
•Tinel and Phalen’s tests
•Brudzinski’s sign
•Kernig’s sign
•Babinski’s sign
•Pronator drift
Psychiatric exams:
•Mini-mental status exam (this isn’t perfect, but the only shorter video I could find)
•Mental status exam (slides but details the components of the mental status exam for the PE section)
General Tips for Step 2 CS
These are things that I learned to do on my school OSCEs and in real life:
-Show genuine empathy and build rapport (e.g. ask about kids names, college major, how they like their job) where appropriate.
-Always lead with open ended questions (at least two).
-Summarize your understanding of the HPI and ask if there is anything he or she would like to add. This reinforces to patients that you are listening to what they are saying.
-When closing an interaction with a standardized patient, always summarize your reasoning behind your diagnosis (or what you want to rule out) and use lay person language and NO abbreviations (yes, most patients know what “COPD” or an “SSRI” is but you don’t want to alienate the few who do not).
-Always ask for understanding and if the patient has any questions
-Always state the plan (in lay persons terms) and if the patient is comfortable with the plan moving forward!
-Where appropriate, you can ask how an issue has affected someone’s life. This can lead to appropriate referrals that will help a patient be compliant with treatment
⇉ Other helpful resources
• Step 2 CK Study Guide
• Step 2 CS Study Guide
• Shelf Resources (by subject)
• Anki Settings Help for Shelf or Step Prep
• How to make Anki Cards Efficiently
• Biostatistics for Step 2
Step 2 Study Guide 